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Pregnancy and childbirth are matters of great importance in a woman’s life. A woman needs to be taken care of and made the centre of attention during this phase. The set of rules that are prescribed in Ayurveda are very important for pregnant women. They give you detailed information about the Vichara (thought process), Vihara (lifestyle) and Ahara (diet) which are recommended to be followed at various stages during the pregnancy period. The general guidelines that are recommended to be followed during pregnancy are:

Do's

Maintain a healthy, mild, easy to digest diet

Keep your food timings regular

Keep your mental health constant and keep yourself happy.

Don'ts

Avoid foods that are spicy or contain too much oil

Do not engage in sexual intercourse, intense work out regimen during pregnancy

Try to avoid negative feelings and general feelings of discontent

Do not cover your abdomen with heavy blankets
While wearing your clothes, do not tie tight knots over your abdomen

Do not change sides during your sleep without getting up

Avoid sleeping on your back and sleep on your sides

In Ayurveda, the guidelines to a healthy pregnancy are given in accordance to months.

First month: A mixture of natural supplements such as khajoor, draksha, vijari and manooka are taken with milk. This mixture is consumed through most of the time. In the first twelve days of pregnancy, drink a mixture of ‘Salaparni’ herb with milk. This mixture should be made in a vessel of precious metal (silver or gold). Also, avoid getting massages during this time and delay that until your fifth month.

Second month: The mixture of the natural supplements with milk is continued.

Thrid month: Drink the above supplements with milk, honey and ghee.

Fourth month: The same mixture is consumed with milk and honey,but the ghee should be replaced with butter.

Fifth month: The supplements are continued and along with it, gentle oil massage is started. Take bath with lukewarm water every day and continue this regimen until delivery.

Sixth month: The fifth month regime is continued.

Seveth month: An itchy and burning sensation on the breast and stomach may be felt during this time as the foetus grows in size. It is recommended to eat in small quantities, have sweet things with ghee or oil to make it easy to digest. Salt intake should be kept at a minimum. Avoid drinking water right after a meal.

Eighth month: Rice is made into a paste and is consumed with milk and ghee.

Ninth month: The eighth month diet should be followed along with oil massages. Massage oil on your belly and genital areas. Hygiene should be maintained to avoid infections. Lubricate your vagina with a cotton ball dipped in oil to provide a smooth passage when the baby is born.

Pregnancy places some restrictions on the expectant mother, and one of them is limiting travel so much so that most women do only the required and essential commutes and skip any other travel, including vacations and business travel, completely until delivery. However, with the lifestyle changing for the woman so radically, this is being revisited. The doctor’s current advice is that unless there are potential complications expected or significant concerns, it is completely safe to travel.

The first trimester especially is a little tricky for travel, with the morning sickness. The second trimester is considered more ideal for travel, as the morning sickness and the feeling of being pregnant is sunk in, so the mother is comfortable. The third trimester is fine too, but the chances of fatigue are higher, and so travel is better avoided.

Read on to know some significant things to remember whether you are on a plane, train, or road during your pregnancy.
Car:

Always buckle yourself up as soon as you enter the car. Use both the seat belt and the lap belt.
Keep the air bags turned on.

Try to avoid travel time of four hours at a stretch.
When stopping for breaks, try to walk around a bit and stretch so that you do not feel the strain of sitting for long hours.

Plane:

Most airlines allow women to travel during the first eight months of pregnancy.
Some airlines do allow for travel during the ninth month, if the doctor approves it, or if there is an attendant with the expectant woman.

It is okay to walk through airport screening during pregnancy. There are some women who are apprehensive about this aspect.

Similarly the cabin pressure in the commercial planes reduces, but does not bear any significant impact for a pregnant woman.
Select an aisle seat, as it allows for easy seating and getting up.

Walking to the restroom and back should be carefully managed. The aisle is quite narrow and care must be taken to avoid hurting yourself.
Use the seats for providing support when walking through the aisle.

Especially, in turbulent stretches, try remaining seated, bearing in mind the safety aspects for yourself and the baby.
Other modes:

Traveling by bus is safe, but trips to the restroom would be difficult.

Trains are generally considered safer, as there is a lot of room for movement. Restrooms are available anytime, which is another major advantage.

Sea travel is also considered safe, but sea sickness could add to the nausea.

For long-term sailing, check with the cruise provider or the boat facility about availability of a healthcare provider on the ship.

How many times have you heard your mom saying that conceiving in your 20s is the best? Or the people around you say that pregnancy post 30 is not a good idea?

All said and done, is getting pregnant after 30 really not advisable? Or is all that just a myth? This post will give you the answers!

A lot of factors determine your planning a baby in your 30s. A lucrative job offer, growing career curve, family responsibilities, etc. are some of the factors that influence your decision. However, studies indicate that it is always better to opt for pregnancy in early 30s than in the late 30s, when conceiving gets difficult. As you approach your mid-30s, it gets more challenging to get pregnant.

If you are 30 and are planning to have a baby, it would be useful to gather more information surrounding the idea. In this post, we discuss everything you need to know about getting pregnant after you turn 30 – the pros and cons of getting pregnant at this age, important measures to take and few facts you must know before you conceive.

Getting Pregnant In 30s – Pros and Cons:
There are two sides to every coin. It is good to evaluate both the pros and cons once you plan to get pregnant in your 30s.

1. Pros About Pregnancy In 30s:
Below are some important aspects that support your timing to conceive after reaching 30 :

By this time, you are already or almost settling in a successful career.

It is the perfect time to get pregnant as you would be financially stable and self-sustaining.
You are now in a position to maintain your finances.
The plans for the future would be more concrete as you have already laid the foundation.

You would have embarked on a meaningful journey with your partner, greeting the idea of togetherness with many vacations, adventures, and getaways.

You are more energetic and full of stamina in your 30s. A perfect time to nourish a baby in your womb!

The levels of follicle stimulating hormone (FSH) grow as you age. There are more possibilities to conceive twins or multiples around this time.

2. Cons About Pregnancy In 30s:

As good as the above factors sound to your ears; there are certain cons you must consider if you plan to get pregnant after 30 :

Your time is running out as you are already 30.
The quality of eggs will constantly decline after you hit the 30 mark. No wonder elders vouch for the 20s folklore
Your chances of getting pregnant are high but not as effective as it would have been in your 20s
Once you are over 35, the odds of conceiving are lower.

You are likely to be exposed to the threat of miscarriage after 30.

Once you are over 35, there is a risk of suffering multiple complications such as ectopic pregnancy, placenta previa, low birth weight babies and premature delivery.
The possibility of fetal abnormalities such as Down’s syndrome is higher after 35.

Things To Do Once You Are Over 30:

The more you are prepared to deal with conception after 30, the easier it would get to cross the river. Here are some important things that you have to do while planning pregnancy after 30:

Get a full gynecological check up done. It includes checking for irregular periods, sexually transmitted diseases, polycystic ovary syndrome (PCOS) and fibroids.

If your partner has a fertility problem, it is now time to consult an experienced therapist.
Consult your doctor if you are over 35 and having sex without contraception for over a year without any results. Further blood tests may be required to check for genetic abnormalities or inhibitors.

Seek immediate medical advice for IVF (In Vitro Fertilization) at the earliest once you know you have issues conceiving.

Keep a check on your lifestyle. Paying attention and following a healthy life pattern helps your chances to get pregnant better.

Some Important Facts Surrounding Pregnancy After 30:

Below are some important facts that you should know about getting pregnant after 30 years of age:

Women who get pregnant after 35 are more likely to have a caesarean delivery.

Women who conceive after 30 are highly exposed to the threat of miscarriage.

Once you are over 30 or 35 and pregnant, you will undergo a detailed examination throughout the pregnancy period.

Tests such as amniocentesis, chorionic villus sampling, etc. will be done to check the health of your baby and the quality of your amniotic fluid.
It is ideal to discuss your plans with your doctor well in advance once you hit 30.

How Are Twins Conceived?

If you want to improve your chances of conceiving with twin babies, firstly understand how twins happen.

There exist two types of twins – identical (non-fraternal) and non-identical (fraternal) .

Nearly one-third of twins are identical, also known as monozygotic twins. They are created by fluke. They develop when one egg is fertilized by one sperm and gets divided into two separate embryos. They share the same genetic composition and placenta. Identical twins can also happen in women who undergo fertility assistance methods.

Non-identical, also known as dizygotic twins, develop when two eggs are fertilized by two sperms. They are unique and do not share genetic composition or placenta. As non-identical twins share only half of the same genetic makeup, they are not always of the same gender.

General Odds Of Having Twins:

The 21st-century statistics show that the possibility of having twins are 3%, i.e., 3 in 100 among the general population. Figures also show that there is an increase of almost 61% from the early 1980s. A much recent numbers from the US National Center for Health Statistics say that the twin birth rate is 33.9 per 1000 live births.

Factors That Determine The Chances Of Having Twins:
As said earlier, identical twins could only happen by sheer chance. But, certain factors could influence the chances of having fraternal twins.

1. Family history / Heredity:

If you are a twin or twins run in your family, you are more likely to have twins. However, if your partner has a twin or twins run his family, it is not going to have any influence on your chances.

It all depends on you because you produce the eggs. If you or your mother is a twin, the probability of twins is high. You will have higher chances of hyperovulation (releasing two eggs during ovulation process). A few specific genes combine with hyperovulation and thus increase the frequency of non-identical twins.

2. Ethnicity / Race:

Your origin also has a strong influence on your chance of having twins. Asians and Hispanics have fewer chances of producing twins, whereas Africans are highly probable, followed by Europeans.

3. Type of body (height/weight):

Yes, this is strange, but taller women are more likely than shorter ones to conceive with twins. Also, heavier women have higher chances than thinner women.

Women who have a well-nourished diet are at a higher probability of producing twins than those who have a reduced and low-fat diet.

A research study published by the American College of Obstetrics and Gynaecology states that the increasing rates of multiple births are due to increased rates of obesity. It found out that women with a body mass index (BMI) of 30 and above are more likely to produce twins. This holds true for only fraternal twins.

4. Maternal age:
Your chance of having twins or more babies increases with advancing age. Women above 35 years produce more FSH (follicle stimulating hormone) than younger women. This hormone allows the ovaries to release eggs for ovulation. The higher the hormone levels, the more are the eggs released during ovulation, thereby resulting in multiple fetuses.

5. More pregnancies:
If you had multiple pregnancies before, there is a high chance of producing twins. The probability of twins improves with increasing number of pregnancies.

Best Ways To Get Pregnant With Twins Naturally:
If you want to try for twins the natural way without resorting to any treatments, try these options out:

1. Consume dairy products:
According to research by Dr. Gary Steinman et al., eating dairy products is correlated to multiple pregnancies. Women who eat dairy have five times more chances to produce twins than women who do not consume these products. Some scientists believe that it is not just the dairy products, but also growth hormones present in milk (dairy from growth hormone-treated cows) help in having twins.

2. Eat wild yams:
Wild yams hyper-stimulate the ovaries, resulting in the release of more than one egg for ovulation. It will, therefore, increase your chances of producing twins. African women have better chances for twins because they consume it as a part of their ethnic diet. Yoruba tribe in West Africa has the highest twinning rate.

Other protein-rich foods with hyper-ovulation stimulating properties are tofu, soy isoflavones, whole wheat and whole grains.

3. Stop birth control pills:
Birth control pills play a pivotal role in helping you conceive twins naturally. When you stop taking the birth control medication, your body takes some time to find its natural rhythm. It causes the body to have a higher hormone flux, than normal. If you try conceiving around this time, there will be a greater chance of having twins.

4. Pregnancy while breastfeeding:
If you still breastfeeding your toddler and get pregnant again, you are more likely to have twins. Your body produces a higher percentage of prolactin during the breastfeeding phase, and it increases your chances of conceiving twins.

5. Have your partner eat zinc rich foods:
Foods rich in zinc like green leafy vegetables, oysters, bread, and seeds stimulate sperm production. It, therefore, improves the probability of fertilizing more than one egg.

6. Have space between pregnancies:
To elevate your chances of conceiving twins, have enough gap between your pregnancies. Quick conceptions hamper your chances of having twins.

Best Sex Positions To Conceive Twins:
Though having twin babies is not in your hands, some sexual positions may increase your probability of having them.

1. Side by side:
It is also known as a doggy style where the woman will position by bending her knees, and her partner will penetrate from behind. In this position, the couple will be able to conceive twins as the cervix will be more approachable to the sperms.

2. Standing up position:
It is also another doggy style where there is a chance of deep penetration.

3. Missionary position:
The man-on-top position helps the sperm to enter the egg easily, and it is the best sex position to produce twins.

4. Rear entry position:
Here, the partner enters from behind, and in this position, the sperm remains close to the cervix of the woman.

Fertility Treatments To Have Twins:
Fertility treatments provide better chances for having twins. Your doctor can suggest the best option for you. However, experts discourage multiple babies through fertility treatments.

IVF ((In vitro Fertilization):
Women who undergo IVF have 20 to 40% chances of giving birth to more than one baby. However, it mainly depends on the number of embryos placed in the uterus. There is also evidence that women undergoing treatments like IVF have fair chances of giving identical twins.

IUI (Intrauterine Insemination):
In this procedure, the sperms are injected into the uterus using a syringe. However, IUI alone will not increase the chances of having multiples. Women who undergo this treatment also take fertility drugs to increase the likelihood.

Fertility Supplements To Get Pregnant With Twins:
Pills and supplements could slightly improve the chances of getting pregnant with twins.

1. Take folic acid supplements:
One Australian study showed that a woman’s chances of producing twins increases by taking folic acid before pregnancy . However, there are also some studies that have shown contradictory results. Nonetheless, taking folic acid supplements, along with multivitamin supplements, helps prevent neural tube deformities, thus producing healthy babies.

New study reports that women undergoing IVF treatments along with excess intake of folate have increased the likelihood of birthing twins.

2. Gonadotropin:
These medications improve the chances of having twin babies as they enhance the overall health of eggs and their maturity. Gonadotropins stimulate the release of more than one egg at a time. Your doctor can prescribe the right one for you.

3. Progesterone:
Progesterone strengthens the lining of the uterus, therefore improving the chances of conceiving twins. When more than one egg gets fertilized, there would be a greater chance for them to attach to the uterus wall, and produce a healthy twin pregnancy.

In most cases, these fertility pills can only produce fraternal twins but not identical as pills can increase multiple eggs to release at a time.

Fertility Herbs For Twins:
There are also certain herbs which help improve fertility, in particular with the conception of twins or multiples.

1. Evening primrose oil:
Primrose oil is famous for its fertility boosting property from centuries. It helps in promoting healthy production of the cervical mucus that flows in the reproductive tract. Healthy mucus allows the sperm to survive for longer days within the ovary. It is advisable to take evening primrose oil at the peak time of menstruation and continue it up to ovulation.

2. Licorice:
This sweet herb regulates the menstrual cycle and makes it easier for you to keep track of your ovulation days. Licorice helps in controlling the hormonal level of testosterone and estrogen, thus supporting the entire process of conception.

3. Flaxseed oil:
Flaxseed oil possesses a great ability to boost fertility in women and increases your chances of conceiving twins naturally. It regulates the hormonal production and maintains a regular menstrual cycle. It ensures a proper balance of progesterone and estrogen hormones.

4. Sweet cassava:
It is the most efficient herbal supplement, known for its effect on fertility. It increases your chances of having twins by its hyper-ovulation property. The potent phytoestrogens present in cassava help in regulating the female hormones.

5. Black cohosh:
This traditional herb can effectively alleviate the symptoms associated with pre-menstrual syndrome (PMS) and menopause. The herb strengthens the uterine muscles and is beneficial for women with weak pelvic floors . Though it does not directly increase the chances of having twins, it improves fertility rates, which may increase the probability of twin babies.

6. Vitex (chaste tree berry):
Vitex helps in treating females suffering from polycystic ovary syndrome (PCOS). The herb helps in regulating the hormone levels, reduces the levels of androgens that contribute towards PCOS and helps in promoting healthy ovulatory function. Vitex helps in the prevention or reduction of ovarian cysts in females. It is useful in improving the probability of twin babies as there is a chance for the woman to double ovulate.

What Is Lexapro (Escitalopram)?

Lexapro (escitalopram) belongs to a group of drugs known as selective serotonin reuptake inhibitors (SSRIs) that alter the serotonin levels in the brain. Serotonin influences the mood and eases depression. The drug is, therefore, used to treat panic disorder, anxiety disorder, and obsessive-compulsive disorder. Lexapro is a brand name of the generic drug escitalopram.

Can You Take Lexapro While Pregnant?

No, it is not safe to take Lexapro during pregnancy as it can affect the mother and the baby. The US Food and Drug Administration (USFDA) ranks Lexapro under category C, which means animal studies have shown adverse effects on the unborn baby, and there are no well-controlled studies in humans.

Lexapro is prescribed for pregnant women only when its potential benefits outweigh the possible risks to the mother or the unborn. The doctor will also consider your gestational age before recommending this drug.
In short, this drug can be taken when there is no other option.

What If You Have Already Taken Lexapro (Escitalopram) During Pregnancy?

If you have been on Lexapro before your pregnancy or have taken it during pregnancy but without any prescription, let your doctor know about it. She can decide whether you can continue or require any other alternative.

Do not stop taking the medication abruptly as it could be dangerous for both you and the unborn. Always take your doctor’s advice before withdrawing from the medicine.

Problems Associated With Weaning Off Lexapro While Pregnant:

Abrupt termination of the medication could result in withdrawal symptoms such as :

Mood changes
Irritability
Agitation
Dizziness
Anxiety
Numbness or tingling sensation in the hands and feet
Headache
Confusion
Difficulty falling asleep

What Are The Side Effects Of Taking Lexapro During Pregnancy?

Recent studies conclude that Lexapro could result in several birth defects in the newborn baby. Some of them are discussed next.

1. Neonatal persistent pulmonary hypertension (PPHN):
According to a public health advisory issued by the USFDA in 2006, antidepressants such as Lexapro and other SSRIs can cause PPHN in babies.

With this condition, the baby will not be able to breathe once outside the mother’s womb and will have to be put on a ventilator, under intensive care. A severe case of PPHN can lead to death as well .

2. Premature birth:
Studies showed that intake of drugs post the first trimester can lead to pregnancy-induced hypertension, an increased risk of miscarriage and even premature birth. It was also found that babies born before 37 weeks of pregnancy are likely to experience health concerns .

3. Autism spectrum disorder:
Use of SSRIs such as Lexapro increases the risk of Autism spectrum disorder, which can impair the child’s ability to interact with people, communicate and develop language skills as they grow .

4. Newborn behavioral syndrome:
The intake of Lexapro and other SSRIs during pregnancy could cause the newborn behavioral syndrome in infants. The symptoms are feeding difficulties, constant crying, jitteriness, breathing problem and seizures .

5. Cleft lip:
According to the Cleft Lip and Palate Foundation, one of the common birth defects that result from SSRIs is facial malformations such as cleft lip and palate.

While cleft lip leaves a gap in the upper lip, the cleft palate creates a gap in the palate when parts of the baby’s face do not join properly during development .

6. Omphalocele:
Although early studies do not suggest that SSRI intake during pregnancy increases the risk of Omphalocele, recent studies indicate otherwise.

Omphalocele is an abnormality in the abdominal wall where the bowel and intestines are outside the baby’s belly. It, therefore, leads to damage of abdominal cavity, organ, and infections .

As you have seen, most of the complications have serious and long-term effects on the baby. And the baby has to suffer for no fault of theirs.

Who Is Liable If Lexapro Leads To Birth Defects?
Studies in the past have linked the use of SSRIs to birth defects in newborns. It, therefore, becomes the moral and legal responsibility of the doctor to inform the pregnant woman about the negative effects of taking Lexapro or any other SSRIs.

In fact, doctors also ask the patients to sign a statement of agreement stating that they understand all the potential risks of using SSRIs during pregnancy.

Also, the pharmaceutical companies, such as Forest Laboratories in the case of Lexapro, hold the obligation of informing the customers about the risks associated with the drugs.

If the doctor fails to inform the patient about the drug’s side effects, and a child is born with birth defects, you have a right to file a legal case against the manufacturer as well as the practitioner who prescribed it.

A healthy diet with the right supplements and an active lifestyle can help ward off depression as well. But if you still think you need to take antidepressants like Lexapro, do so only if your doctor prescribes it. The bottom line is to follow the specific suggestions and take only the prescribed medications as advised by your doctor.

Dr. Kalpana Dongre Ladde
Dr. Kalpana Dongre Ladde
BAMS, Ayurveda Family Physician, 11 yrs, Pune
Dr. Sairandhri Shinde
Dr. Sairandhri Shinde
MBBS, Gynaecologist Infertility Specialist, 10 yrs, Pune
Dr. Vijay Hatankar
Dr. Vijay Hatankar
MS/MD - Ayurveda, Ayurveda Family Physician, 21 yrs, Pune
Dr. Sachin Hundekari
Dr. Sachin Hundekari
MBBS, Cardiologist, 4 yrs, Pune
Dr. Abhijit Shirude
Dr. Abhijit Shirude
MS - Allopathy, ENT Specialist, 5 yrs, Pune
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